While women have less risk of heart disease than men prior to menopause, heart disease is a leading cause of death for older women.

Survival rates from heart attacks in New Zealand have improved over the past 20 years due to advances in treatment, and while the number of heart attacks have not fallen, the age at which they occur is getting older.

Heart disease rates in New Zealand remain one of the highest in the western world and are higher than Australia, America and Canada.

Dr Swinburn said there for two reasons for New Zealand's high rate: the high cholesterol levels in the New Zealand population due to a high-fat diet, and New Zealand's low rate of appropriate secondary prevention (further prevention after a heart attack).

In other countries, people who have had heart attacks are treated more readily with drug treatment than they are in New Zealand.

Maori women are three times more at risk of heart disease than European women, but when their rate is adjusted for risk factors such as obesity and socio-economic factors, their risk may be lower than other cultures. Indian populations, however, have a genetic predisposition to heart attacks.

Dr Swinburn said while adopting a more healthy lifestyle can help to reduce the risks of heart disease in low risk populations, the biggest health gains are made when those at high risk of a heart attack or those who have already had one make healthy lifestyle changes.

Risk factors for heart disease

High blood pressure

Hypertension is a big risk factor for heart disease and 18 percent of New Zealand adults have high blood pressure over 160/95.

Dr Swinburn said factors predisposing to high blood pressure include obesity, lack of physical activity, and a high alcohol intake. However, these factors only explain a small proportion in the variation in blood pressure.

"There's quite a lot about blood pressure that we can't explain," he said.

Recent research suggests that New Zealand blood pressure is coming down which could be put down to improving diet.

Blood cholesterol levels

Blood cholesterol levels have dropped since the late 1980s in New Zealand, however rates are still higher than that of Australia, and are high by international standards.

New Zealanders have an average cholesterol level of 5.7 mmol/l, compared to an American level of about 5.4.mmol/l

Dr Swinburn said a 5 percent decline in cholesterol level translates to at least a 10 percent reduction in deaths from heart disease.

He said New Zealand's high cholesterol levels relate to a diet high in animal fat.

Obesity

The New Zealand population is getting heavier which is another factor in heart disease. Obesity in New Zealand has increased by 50 percent in the past eight years - a problem also being experienced by other countries.

Increasing obesity is also leading to increasing rates of diabetes in the population.

The fat content in the New Zealand diet is high at 35 percent.

The amount of physical activity in people's jobs and lives is also decreasing due to labour saving devices.

Recreational physical activity is increasing, which Dr Swinburn said can help to make a difference.

Smoking

The rate of smoking in New Zealand declined during the 1980s but the level has now evened out.

The biggest concern about smoking comes from smoking rates in young teenagers. A recent survey has found 16 percent of 14 year old girls smoking everyday.

Dr Swinburn believes the high rate of smoking can be put down to a number of factors including children getting extra pocket money, the number of lead males in movies filmed smoking, and the extra additives put in cigarettes to make them easier to smoke.

"The product what they are smoking now is a very, very different product to what people what were smoking when they were 14. It is much more addictive and much easier to smoke," Dr Swinburn said.

He said more than 600 additives are added to cigarettes in New Zealand, and there are no regulations governing this.

Physical activity

Activity is necessary to help keep fit and reduce the risks of heart attacks. However, labour saving devices and more sedentary occupations are limiting the amount of exercise people get.

Diet

The New Zealand diet is improving but the average diet remains high in fat, and New Zealanders are still the largest butter eaters in the world.

Fifty percent of people still prefer to drink homogenised milk, rather than reduced fat alternatives.

Women eat more vegetables than men with 73 percent eating three or more servings a day compared to 62 percent of men. One third of women also take dietary supplements.

Dr Swinburn said despite the fact women's eating patterns are healthier than men they can still make further dietary changes.

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